| NPI | 1053895441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01822700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048371) |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2023-12-21 |